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U.S. public health victory over TB stems from multi-pronged attack

By Pam MellskogLongmont Times-Call

Posted:
01/23/2012 10:58:04 PM MST

Updated:
02/08/2012 07:47:44 PM MST

Some time between 1900 and 1920, photographer Charles W. Boynton snapped this image of the men, women and children living at the Hygiene Sanitarium in Hygiene. The sanitarium, like so many statewide at that time, treated tuberculosis patients from near and far who hoped to recover from the bacterial infection that led to chronic coughing, weight loss, fevers and night sweats with the possibility of death. These patients and their caregivers mistakenly believed that Colorado's high altitude, fresh air and year 'round sunshine would ward off the disease. When antibiotics debuted in the late 1940s, doctors began effectively treating TB patients, which ultimately closed the sanitariums. (Courtesy of the Longmont Museum and Cultural Center)

LONGMONT -- His public health career investigating tuberculosis often brings Dr. Randall Reves face to face with a past most Americans never consider.

"One person said that his (TB-infected) father was to live in a lean-to outside of the house so as not to infect the children," said Reves, medical director of the Denver Metro TB Control Program.

While that might have been prudent before effective antibiotic treatments became available more than 60 years ago, the Longmont High School student diagnosed last week with active tuberculosis -- a bacterial infection that causes coughing with bloody phlegm, weight loss, fever and night sweats -- should be safely back to school within two to three weeks, Reves said.

However, the reason TB cases in the United States are so rare -- Boulder County reports five to seven cases annually and the state reported 71 cases total last year, he said -- goes beyond medication.

The triumph of public health departments in quelling the disease still common in Asia, Africa and Latin America comes from two other factors: state laws that mandate directly observed antibiotic treatments by public health personnel for anyone diagnosed with active TB, and vigilance on behalf of investigators in identifying people around the patient who have so-called latent TB.

Latent TB causes no immediate symptoms, but untreated latent TB can eventually develop in to active TB, said Carolyn Bargman, a case manager and nurse evaluator/investigator.

Boulder County Health contracts her services through Reves' TB Control Program to investigate the Longmont High School case and all others countywide with one other colleague.

"In this country, we are lucky to have the resources to treat latent infection," Bargman continued. "Other countries have to focus on the active cases because they have so many of them." Her work begins with onsite visits to the active TB patient's home and school or workplace. There, she interviews close associates.

Besides proximity, Bargman considers anyone with a compromised immune system due to taking certain medications for arthritis or Crohn's disease and anyone undergoing cancer treatments, fighting HIV or living with diabetes as more at-risk of infection.

She targets the people around the TB patient in ever-widening circles until no one tests positive for active or latent TB.

Reves said that this strategy makes sense because only about 10 percent of those who get infected with TB immediately become ill with active TB. The remaining 90 percent walk around with latent TB.

"Most of the TB in the United States now is not due to someone who recently got infected, but to someone who got infected years ago," Reves said.

The good news is that, though TB ranked a century ago as the top killer of young, otherwise healthy people living in crowded American cities, modern public health methods of stamping out the disease work, he continued.

Today, infection statistics show that 70 percent of TB in the United States is diagnosed in foreign-born people, Reves said. And U.S-born active TB patients typically are either the children of foreign-born parents who brought TB with them to this country or the elderly who were exposed decades earlier, when TB was more widespread here.

"But you have to be cautious about blaming the immigrants," Reves said. "There's nothing that they did wrong to get it. A lot of people will feel a sense of shame. But there's nothing to be ashamed of. The important thing is to get diagnosed and treated."

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